Modern Drug Rehab Computer

---
license: Apache-2.0
visibility: private
name: modern-drug-rehab-computer
description: Comprehensive knowledge system for addiction recovery environments, supporting both residential and outpatient (IOP/PHP) patients. Expert in evidence-based treatment modalities (CBT, DBT, MI, EMDR, MAT), recovery resources, coping strategies, crisis intervention, family systems, and holistic wellness. Activate on "rehab", "addiction recovery", "substance abuse", "treatment center", "IOP", "PHP", "detox", "sobriety support", "MAT", "Suboxone", "methadone", "12 step", "SMART Recovery". NOT for prescribing medications (consult medical professionals), emergency overdose situations (call 911), or replacing licensed counselors/therapists.
allowed-tools: Read,Write,Edit,WebFetch,WebSearch
category: Recovery & Wellness
tags:
  - drug-rehabilitation
  - technology
  - treatment
  - recovery
  - digital-health
pairs-with:
  - skill: sober-addict-protector
    reason: Daily relapse prevention
  - skill: jungian-psychologist
    reason: Psychological depth for recovery
---

# Modern Drug Rehab Computer

Comprehensive recovery guidance system for individuals navigating addiction treatment and early recovery.

## DECISION POINTS

### Craving/Urge Response Matrix

```
INTENSITY LEVEL → ACTION PATH

1-3 (Mild):
├── Apply HALT check (hungry/angry/lonely/tired)
├── Use 5-4-3-2-1 grounding
├── Continue current activity
└── Note trigger in journal

4-6 (Moderate):
├── Stop current activity immediately
├── Contact accountability person (text/call)
├── Apply TIP skills (temperature/exercise/breathing)
├── Remove yourself from triggering environment
└── If persists >30 min → escalate to 7-10 response

7-10 (Severe):
├── Emergency contact (sponsor/counselor/crisis line)
├── Go to safe location immediately
├── Consider emergency meeting attendance
├── If thoughts of using are specific → crisis intervention
└── DO NOT isolate - stay with safe person

SPECIAL CONDITIONS:
├── At family event → buddy system + exit strategy
├── In treatment setting → immediate staff notification
├── Post-detox (first 30 days) → lower threshold for escalation
└── PAWS symptoms → medical consultation if persistent
```

### Treatment Modality Selection

```
PATIENT PROFILE → RECOMMENDED APPROACH

Trauma History + Addiction:
├── Primary: EMDR or trauma-informed CBT
├── Secondary: DBT for emotional regulation
├── MAT if opioid/alcohol involved
└── Avoid exposure therapy until stabilized

High Emotional Dysregulation:
├── Primary: DBT (distress tolerance focus)
├── Secondary: Mindfulness-based interventions
├── Consider psychiatric evaluation
└── Structure over insight-based therapy initially

Motivation Ambivalence:
├── Primary: Motivational Interviewing
├── Avoid confrontational approaches
├── Focus on discrepancy between values/behavior
└── Let patient argue for change

Opioid Use Disorder:
├── MAT evaluation within 24-48 hours
├── Buprenorphine if mild-moderate withdrawal
├── Methadone if severe dependency/failed bup
├── Vivitrol only after 7-14 days clean
└── Combine with psychosocial treatment always
```

### Crisis Intervention Thresholds

```
PRESENTATION → IMMEDIATE ACTION

Active suicidal ideation with plan:
├── 988 crisis line or 911
├── Do not leave person alone
├── Remove means if accessible
└── Transport to emergency room

Active withdrawal symptoms:
├── Medical evaluation within 4 hours
├── Alcohol withdrawal → ER (seizure risk)
├── Opioid withdrawal → comfort measures + MAT consult
└── Benzo withdrawal → medical supervision required

Relapse with medical complications:
├── Overdose risk assessment
├── Tolerance may be reduced
├── 911 if unconscious/slow breathing
└── Medical clearance before treatment re-entry

Family crisis/domestic violence:
├── Safety planning immediate priority
├── Remove from unsafe environment
├── Connect with domestic violence resources
└── Treatment secondary to safety
```

## FAILURE MODES

### 1. White-Knuckling (Willpower Dependency)
**Detection**: Patient relies solely on determination, avoids tools/support, says "I should be stronger"
**Symptoms**: Increasing irritability, isolation, "I don't need meetings/medication"
**Fix**: Reframe recovery as skill-building, not character test. Introduce concrete coping tools. Address shame around needing help.

### 2. Program Shopping (Perpetual Seeking)
**Detection**: Frequently changing programs, blaming failures on "wrong approach," never completing treatment
**Symptoms**: "This program doesn't work for me," constant research into new methods
**Fix**: Commit to one evidence-based approach for 90+ days. Address underlying perfectionism/control issues.

### 3. Dry Drunk Syndrome (Abstinence Without Recovery)
**Detection**: Stopped using but mood, relationships, and functioning remain poor; increased irritability, depression
**Symptoms**: "I'm miserable sober," relationship conflicts, emotional instability despite abstinence
**Fix**: Focus on underlying mental health, trauma work, relationship skills. Recovery is more than not using.

### 4. All-or-Nothing Relapse Response (Relapse = Failure)
**Detection**: After any slip, patient abandons all recovery efforts, "I've blown it completely"
**Symptoms**: Binge after minor slip, quitting treatment post-relapse, shame spiraling
**Fix**: Normalize slips as part of learning process. Immediate re-engagement strategy. Harm reduction mindset.

### 5. Medication Stigma Trap (MAT Avoidance)
**Detection**: Refusing MAT due to "not being really sober," pressure from others, shame about medication
**Symptoms**: Multiple failed attempts without MAT, listening to anti-MAT voices in recovery community
**Fix**: Education on brain disease model, connecting with MAT-positive peers, addressing internalized stigma.

## WORKED EXAMPLES

### Example 1: Early Recovery Craving Episode

**Scenario**: Day 45 in IOP, patient Sarah texts at 7 PM: "Having massive craving. Just drove past my dealer's street. Don't know what to do."

**Expert Response Process**:
1. **Immediate triage**: Assess current location/safety - still in car near dealer?
2. **Intensity assessment**: Rate 1-10 → Sarah says "8"
3. **Apply 7-10 protocol**: 
   - Direct her to drive to safe location (coffee shop, meeting)
   - Stay on phone/text until she's there
   - Have her call sponsor while driving
4. **HALT check**: Hasn't eaten since noon (hungry), angry about job rejection today
5. **Physical intervention**: Order food, use ice cubes for TIP skills
6. **Follow-up plan**: Stay at coffee shop 1 hour, attend 8:30 meeting
7. **Next day processing**: Discuss trigger sequence in therapy

**Novice mistake**: Would focus on "willpower" or shame about the craving
**Expert insight**: Cravings are neurobiological - treat with behavioral interventions, not moral judgment

### Example 2: Family Visit During Treatment

**Scenario**: Jake, 30 days residential, family visiting this weekend. Parents historically critical, triggering shame and previous relapses.

**Expert Preparation Strategy**:
1. **Pre-visit planning**: Role-play difficult conversations in therapy
2. **Boundary setting**: Communicate visit structure to family beforehand
3. **Exit strategy**: Clear plan for shortened visit if needed
4. **Support activation**: Sponsor on standby, group members aware
5. **Emotional preparation**: Process family trauma in therapy sessions
6. **During visit**: 
   - Structured activities (avoid unstructured time)
   - Check-ins with staff every 2 hours
   - Use bathroom breaks for grounding exercises
7. **Post-visit debrief**: Process emotions in next therapy session

**Novice approach**: "Just get through it" without preparation
**Expert insight**: Family visits are high-risk periods requiring active management

### Example 3: PAWS vs. Depression Treatment Choice

**Scenario**: Month 3 recovery, persistent depression, fatigue, anhedonia. Question: Start antidepressant or wait for PAWS to resolve?

**Expert Decision Tree**:
1. **Timeline assessment**: When did symptoms start? Pre-use, during use, or post-cessation?
2. **Severity evaluation**: Functional impairment level? Suicidal ideation?
3. **Previous episodes**: History of depression independent of substance use?
4. **Substance of choice**: Alcohol/depressants more likely PAWS, stimulants may mask depression
5. **Decision matrix**:
   - If symptoms pre-date substance use + functional impairment → medication trial
   - If closely tied to cessation + mild-moderate severity → wait 6 months with close monitoring
   - If suicidal ideation present → immediate psychiatric evaluation
   - If mixed picture → 3-month intensive therapy trial first

**Novice error**: Assuming all post-cessation depression is PAWS
**Expert nuance**: Distinguish between neurochemical rebalancing and underlying mood disorders

## QUALITY GATES

Recovery Support Mastery Checklist:

- [ ] Can demonstrate 3+ coping skills under stress without prompting
- [ ] Has identified specific personal triggers and corresponding response plans
- [ ] Maintains regular contact with recovery support network (weekly minimum)
- [ ] Can explain their medication regimen and when to contact medical team
- [ ] Has completed crisis contact list and shared with family/friends
- [ ] Demonstrates understanding of HALT principles and applies them consistently
- [ ] Can articulate the difference between slip and relapse with recovery plan for each
- [ ] Has established consistent daily structure including sleep/meal times
- [ ] Shows evidence of processing trauma/underlying issues in therapy
- [ ] Can identify warning signs of mental health deterioration and help-seeking steps

## NOT-FOR BOUNDARIES

**DO NOT use this skill for:**
- Prescribing or adjusting medications → defer to medical team
- Crisis intervention with active suicidal ideation → use crisis-intervention-specialist
- Active overdose situations → call 911 immediately
- Family therapy facilitation → refer to family-systems-therapist
- Trauma processing → use trauma-therapy-specialist
- Legal advice regarding treatment or addiction-related charges → legal professional
- Employment/disability determinations → vocational counselor
- Child custody issues related to addiction → family law attorney

**Refer to other skills:**
- Daily relapse prevention → sober-addict-protector
- Deep psychological work → jungian-psychologist
- Communication with partners → partner-text-coach
- Emotional regulation → hrv-alexithymia-expert